Understanding Codependency

The Science Behind It

The groundbreaking book Understanding Co-Dependency ushered in a new way of thinking about codependency and helped millions of people discover if they were co-dependent, if they were living with a co-dependent, and how to break the cycle. Now, in this revised edition, Joseph Cruse, founding medical director of The Betty Ford Center, provides findings and insights into codependency. Thirty years ago, clinicians viewed alcoholism as a liver disease; today research has revealed that addiction and many codependent behaviors are related to brain functioning. Cruse explores this brain connection and expands on the all-important issues of traumas it relates to codependency, denial, low self-esteem, and self-worth. With updated case studies and exercises, Understanding Codependency dispels the notion that the cycle of codependency can't be broken, offering readers a lifeline to the fulfilling relationships and lives they deserve.

Sharon Wegscheider-Cruse

Sharon Wegscheider-Cruse is the founder of Onsite Workshops in Tennessee and the founding chairperson of the National Association for Children of Alcoholics. She is a nationally known consultant, educator, and bestselling author of seventeen books, many of which have been translated to French, German, Spanish, Greek, Portuguese, and Japanese. As a family therapist, she has conducted workshops around the world consulting with the military, school systems, business and industry, treatment centers and corporations. She is a past winner of the Marty Mann award as a top communicator and has appeared on "The Phil Donahue Show," "The Oprah Winfrey Show" twice, and "Good Morning America." She lives in Las Vegas.

Joseph Cruse

Joseph Cruse, M.D., is an oncologist, addiction medicine specialist, author, writer, and lecturer. He is the founding medical director of the Betty Ford Center. He served as president of the medical staff at Eisenhower Hospital and as a medical director of onsite workshops. He is a consultant to industry, school systems, hospitals, and alcohol and drug treatment centers. He has appeared on 60 Minutes, Good Morning America, and The Late Night Show.

Thirty-one years ago alcohol rehab facilities began to promote their treatment facilities and extend their treatment techniques to individuals who were dependent on (addicted to) substances other than alcohol (heroin, cocaine, narcotic/sedative medications, etc.). In an effort to describe these individuals, the terms chemically dependent andchemical dependency became popular.

People were confused and upset by the use of the term chemical dependency. 'Of course, I am dependent on chemicals, just as I am to the soap in my dishwasher, the rubber in my tires, and the air that I breathe. What a silly term—no clinical help at all!' But the term has stuck and is in popular usage by both professionals and the public at large.

Codependency

Prior to the use of the term chemical dependency, family members, particularly spouses, were described as co-alcoholics. Therefore, when the term chemically dependent began to be used, it became almost second nature to describe the spouse and family members as codependents.

The word 'codependency'has been shortened (codep, co-), restricted (only for the co-alcoholic or co-addict), and expanded into general usage to describe almost any persistent preoccupation a person may have. It has been changed from a hyphenated word, 'co-dependency,' which indicates a co-occurring event, to a nonhyphenated, single word, 'codependency,' which indicates a stand-alone event. No wonder there is confusion, especially since the meaning of the original word never actually received complete agreement from the professional treatment field or individuals in the 'recovery' arena.

The stand-alone word 'codependency' is probably the form of the word that is most popular. It can still be used to describe a co-alcoholic or a codependent, and it can also be used to describe individuals with dependencies and addictions that evolve from negative or excessive involvement in other areas. Examples of this include behaviors or activities that capture a person's interest and detract from their usual environments of family, friends, and work, such as gambling (in person and online), technology, sexual acting out (affairs, online pornography, etc.), overeating or not eating, and so on, to name just a few. Dependence on or addiction to these activities results in an emotional divorce from family, friends, and coworkers, and the individual figuratively moves in with a mistress who is represented by the behavior or activity. This is recognized as an actual addiction when it reaches advanced stages. It is called process addiction (or behavioral addiction).

Process addiction is a recurring, compulsive condition whereby a person engages in an unrestrained, specific activity despite harmful consequences to his or her health, mental state, or community life. Behavioral addiction, like codependency, is considered harmful if it results in negative consequences for the person and for those with whom they associate. People can be addicted to gambling, food, sex, pornography, computers and the Internet, video games, work, exercise, spiritual obsession (as opposed to religious devotion), shopping, cutting, and pain.

Using the term codependency has certain benefits. It can act as a shortcut to understanding the nature of addiction. But giving a name to the state of being codependent does not necessarily mean that there is an immediate or even effective permanent solution for it, so the term must be used with caution. There are a large number of therapies available for many different mental health conditions, including codependency. Some are helpful and some are not.

In summary, codependency is still frequently the 'diagnosis' attached to the behavior, thoughts, or 'condition' of a person who is involved in a highly dependent relationship with someone who requires extra care or vigilance, such as a practicing alcoholic or drug addict. Even so, it has been difficult for the treatment field to convince the decision- makers that here, indeed, is a treatable condition that can be diagnosed, has evidence-based treatment available, and for which therapists should receive reimbursement.

The New Oxford American Dictionary defines codependency as 'excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction,' and codependent as '1 (dependent on/upon) contingent on or determined by; 2 a person who relies on another, esp. a family member, for financial, emotional, or other support; unable to do without: people dependent on drugs' (authors' emphasis).

Now, with the passage of time and our recent experiences and new discoveries regarding brain function in compulsive and addictive diseases, our understanding of codependency has improved. It is possible to relate the dynamics of codependency to existing knowledge regarding brain function, personality characteristics, childhood trauma, and social influences. Acceptance and recognition of codependency has increased.

Behavior that appears briefly and with little impact on the life of an individual might be termed 'transient' or 'temporary.' The distinction is mentioned here because 'That's codependent!' is frequently used in casual conversations, where it might not apply to the more recent definition of the condition.

Codependency Minor

Behavior that is of concern to the individual per se and not necessarily to those around him or her might be termed 'minor.' Individuals with codependency minor are usually experiencing unease rather than disease. They know that something is amiss or going amiss and they have some insight into it. They have enough self-worth that seeking help and guidance is the first thing they do. They might be termed 'the worried well.' They profit greatly from their realistic self-intervention.

Codependency Major

Codependent behavior that is seriously impacting the life of an individual and those in the individual's environment (home, work, social circle, etc.) might be termed as 'major.' These individuals have developed enough of a denial system that complications are occurring in numerous areas of their lives. They deny the severity or even the existence of their problems. They externalize their beliefs as to the cause of their problems. They develop compulsions that help to suppress the negative feelings they have. They believe the solutions reside outside themselves, and they live in an 'if only' world. 'Everything would be okay, if only . . .' They might be described quite accurately as 'the walking wounded.'

This is not meant to label those with mental illness or those who require counseling and guidance, as we all do from time to time, but rather this is an effort to place a condition in its rightful place in a continuum of health and illness in their varying degrees. If we can be clear in our use of the word, then we can communicate with more accuracy, without judgment or labels, and individuals who read this will be empowered to do what is necessary to improve their lives and find solutions to their problems.

We know there is a group of individuals who may have serious and fixed thoughts and behaviors that led them into complications at an early age. These are now expanded to include children from any home where any addiction is present or where even nonaddicted but dysfunctional behavior from other sources occurs. Early onset often results in major codependency. Some children grow up with resiliency and enter adulthood with a strong sense of self. A small percentage are fortunate enough to have been through formal therapy or training for codependency, and they too can become very resilient.

Other children who live in the midst of dysfunctional families often grow up with major living problems and usually do not begin their search for help until they are adults. There are treatment and support organizations for them, such as the National Association of Children of Alcoholics (NACoA, in Washington, D.C.) and several 12-step support groups, including Adult Children of Alcoholics (ACoA), Codependents Anonymous (CoDA), and Alateen/Alanon.

All of us have mental, emotional, and behavioral problems that occur throughout our lives and that require attention and resolution from time to time. These problems are a natural part of life, and each of us is responsible for seeking the solutions to the problems that arise in our lives. We need knowledge, sometimes outside help, and certainly a belief that while there may be problems, they can be fixed.

Welcome to the Revised Edition of Understanding Codependency

This edition contains new material that expands on and validates the information given in the first edition, as well as some editorial revisions to the text. A new chapter on codependency and the functions of the brain has been added, and we have also added text that confirms that symptoms of codependency are Brain Events and what we call complications of codependency are Life Events. Additionally, another new chapter, 'Sorting Out Codependency,' gives readers more in-depth information that will help them discern if codependency is impacting their lives and what to do about it in terms of treatment and recovery. Last, a section containing the references for the new edition and an updated list of resources are presented.